Presented to Defense Health Board, 10Feb16
Commanding Officer, NATO Role 3 MMU
Kandahar Airfield Afghanistan
Mike Rotation, 30 Mar - 9 Oct 2015
PERSPECTIVES OF A DEPLOYED COMBAT
HOSPITAL COMMANDER
Disclaimer
The views expressed in this presentation are
those of the author and do not necessarily
reflect the official policy or position of the
Department of the Navy, Department of
Defense, nor the U.S. Government.
AOR Roles (Echelons) of Care
Role 1, Point of Injury Care: First aid, buddy aid, Combat Medic; first aid, triage, resuscitation, and stabilization
Role 2, Damage Control Surgery: 100% mobile, 72 hr ops (30 surg max), hold/manage 8 intensive care pts for 6 hrs
• Army FST: 1 Ortho/3 Gen Surg, 2 CRNAs, CCRNs, Surg Techs
• Can deliver packed RBCs, limited x-ray/lab
• Role 2E – basic secondary health care built around primary surgery, intensivecare units and ward beds. Able to stabilize post surgical cases for evac to Role4 without the requirement to first route them through a Role 3
Role 3, All Patient Categories: resuscitation, initial wound surgery, damage control surgery, postoperative treatment, Intensive Care Unit
• Others: Army Combat Support Hospital, Navy Hospital Ships/EMFs
• Neurosurgery, Ophthalmology, ENT, Urology, OMFS can be included
• Advanced Imaging (CT), Comprehensive Lab & Pharmacy
Role 4: CONUS or other safe haven based hospital (Landstuhl Reg Med Ctr)
Kandahar City ~8 miles - 5th largest city in Afghanistan, ~1M
- Founded by Alexander the Great ~330 BC
Kandahar Airfield (Joint Mil/Civ Airport) - Built as US refueling base to SWA late 50s
- Soviet air base during occupation
- US airstrikes began Oct 01
- Facility taken by 26th MEU, Dec 01
Historical Background
UNCLASSIFIED//FOR OFFICIAL USE
ONLY
US Army, 48th Combat Support
Hospital Role 2E, 2002-2006
• 82nd Airborne Paratrooper killed in action near Neshkin AFG
on 25 April 2003
• Awarded a Silver Star for the action in which he rescued
multiple fellow soldiers under fire following an enemy ambush
PFC Jerod Dennis
Initial assistance from US,
UK, Denmark, Netherland
and New Zealand
s
Canada was Assigned as Lead Nation
in 2005 for a New Role 3 Capability
Feb 2006: Canada takes possession of
the PFC Jerod Dennis Hospital
“The Wooden Palace”
• CT scanner x2
• OR x3
• Digital Radiography
• 5-8 ICU beds
• 20-30 Inpt beds
October 15, 2009: US Navy Assumes Lead
May 23, 2010: NATO Role 3 MMU Opens
Planning & Construction (NATO)
3.5 years to plan; 18 mths to build
German engineered and designed
70,000 sq ft
Cost estimated at $39M
NATO Support Agency (NSPA)
NATO Version of NMLC
Facility/Physical Plant maintenance
Housekeeping
Up to FY 15 Role 3 Budget
OPTAR - $2.0M allocation
FY 15 Medical Equipment
655 items, Current Value = $4.7M
Acquisition Costs = $8.4M
Mortar/Rocket resistant exterior
Advanced physical plant
Oxygen generation, air filtration
Power generation / UPS
Zoned controlled HVAC and Fire Suppression
Facility Data
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Outpatient
Inpatient
Outpatient
Inpatient
Outpatient & Inpatient Data
CY 2013 - September 2015
4 Full Scope Trauma Bays
+8 ER Beds UNwCLA/ PortSSIFIEabD//FOle R TOFFICIAraumaL USE Co nfiguration
Emergency Department
MIKE Rotation
PATIENTS BATTLE
INJURIES
ADMISSIONS
MARCH 17 0 0
APRIL 79 7 16
MAY 61 5 8
JUNE 63 1 8
JULY 71 3 11
AUGUST 81 6 12
SEPTEMBER 50 1 3
TOTALS 422 23 58
86% Return to Unit (RTU) Rate
14% Admission Rate
Emergency Department
MIKE Rotation
76%
17%
7%
Alpha Bravo Charlie
Airlift for patients to an initial
MTF – Conducted by rotary
assets in the forward area
CAT A - Urgent transport to save life, limb, or
eyesight (LLE) within 60 minutes
CAT B - Priority transport needed for trauma
patients requiring surgical evaluation
within 4 hours
CAT C - Routine transport for patients
requiring treatment from a MTF with
greater than Role 1 capabilities within
24 hours
Forward MEDEVAC to Role 3
Role 3 Navy Providers (Total Staff = 87)
– Emergency Medicine - 3 – Orthopedic Surgeon - 1
– Critical Care Medicine - 3 – Neurosurgeon - 1
– Anesthesiologists - 3 – Radiologist - 1
– Trauma Surgeons - 2 – Psychiatrist - 1
– General Surgeon - 1 – Physical Therapist - 1
Role 1 Army Providers
Family Medicine - 1 Psychologist - 1
Dentist - 1 Social Worker - 1
MIKE Rotation Medical Assets
• Emergency/Trauma Nurses - 6
• Perioperative Nurses - 4
• Intensive/Critical Care Nurses -12
• Enlisted Corpsmen/Support Staff - 36
General Duty HMs - 12
Surgery Technicians - 5
Laboratory Techs - 3
Radiology Techs - 3
Pharmacy Techs - 3
BioMed Repair Techs - 3
Physical Therapy Tech - 1
Psychiatry Tech - 1
Nurses, Corpsmen, & Support Staff
• Major trauma
– Neck, chest, abdomen, pelvis
– Vascular
• Neurosurgical
– Emergency brain operations
– Intracranial pressure
monitoring
– Spine stabilization
• Orthopedics
– Stabilization – external
fixation
– Internal fracture repair
– Wound debridement
– Negative pressure dressings
Main ORs - 3
Minor Procedure Room - 1
Laparoscopic equipment - 3
Orthopedic Fluoroscopy C-arms - 2
Upper Endoscopy - 2
Colonoscopy - 1
Pulmonary Bronchoscopy - 2
Surgery & Operating Room
• Critical Care Physicians - 3
• Critical Care Nurses - 9
• Respiratory Therapists - 2
• Beds - 12
• Bedside Monitors - 12
• Mechanical Ventilators - 14
Intensive Care Unit
• Wards - 2
• Beds - 16
• Isolation beds - 4
• Medical Hold (Cots) - 6
• Hospital-wide bed expansion (Cots) - 24
Inpatient Wards
Tier Patient Load Resources
I <4 • Trauma Teams - 3
II 4-7 • Trauma Teams - 3
• Navy Auxiliary Trauma Team - 1
• TMC Auxiliary Trauma Team - 1
• Forward Surgical Team - 1
• Walking Blood Bank
III 8+ • Trauma Teams - 3
• Navy Auxiliary Trauma Team - 1
• TMC Auxiliary Trauma Team - 1
• Forward Surgical Team - 1
• Walking Blood Bank
• Base Security
• Non-Role 3 Medical Assets
• Logistics/Patient Movement
• External Resources (BAF)
Trauma Response Plan
Canadian Era: 2006-2009 (44 mths)
• 4134 pts, 6735 procedures
• 25% NATO, remainder = ANSF/civ
USN Era:
Awarded Navy Unit Commendation
• 15 Oct 2009 to 30 April 2012
• 2100 pts treated per year.
Historical Summary
MISSION SUCCESS IS DUE TO THE EFFORTS OF
87 DEDICATED AND MOTIVATED
PROFESSIONALS SERVING WITH HONOR
MIKE ROTATION: 30 MAR - 09 OCT 2015
US NAVY RESERVE COMPONENT: 48/87, 55%
US NAVY ACTIVE COMPONENT: 39/87, 45%
Questions?
